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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 570306190
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:24:29 AM

Document Has Been Signed on 03/28/2024 10:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MONTESSORI COUNTRY DAYFACILITY NUMBER:
570306190
ADMINISTRATOR:ROBERTSON, DEBBIEFACILITY TYPE:
850
ADDRESS:1811 RENOIRTELEPHONE:
(530) 753-8373
CITY:DAVISSTATE: CAZIP CODE:
95618
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 38DATE:
03/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Debbie RobertsonTIME COMPLETED:
10:40 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jennie Tedlos conducted a case management inspection to deliver an Immediate Exclusion Order. The employee being served is Shah Naveed.

Licensing staff did not observe Ms. Naveed to be present at the facility today. Director, Debbie Robertson, stated that this facility, has not employed Ms. Naveed for several years and had sent in the Confirmation of Removal a couple months ago immediately upon receiving the Exemption Denial.

Today, the Director, Debbie Robertson, was advised and understands that the individual listed above cannot be present at this facility.

An exit interview was conducted with the Director.

LPA reviewed report with the Director, Debbie Robertson, and provided copies of the report along with Appeal Rights. A notice of site visit was provided and posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


No Title 22 Deficiencies were cited during the visit.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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